脓毒症和感染性休克;当前儿科干细胞治疗的困境和作用

IF 0.5 Q4 PEDIATRICS
Gokcen Dinc, Z. B. Gonen, Jafar Soltani, M. Doğanay
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引用次数: 0

摘要

背景:脓毒症的主要治疗包括抗生素治疗、支持治疗和感染源控制。这种方法的失败率约为20 - 40%。抗生素的广泛使用导致社区获得性和卫生保健相关感染的脓毒症的主要病因产生多重耐药。在没有新的抗生素选择的情况下,替代治疗方式似乎是必要的。证据获取:在此,我们回顾并讨论了目前脓毒症管理和干细胞治疗在脓毒症、临床前、实验研究和早期临床试验中使用干细胞治疗脓毒症的问题。在论文准备过程中,通过关键词(脓毒症和细胞治疗、脓毒性休克、细胞治疗)检索PubMed、Web of Science Core Collection (Clarivate)、Scopus和网址(www.clinicaltrials.gov)。结果:纳入标准后,我们回顾了301篇原创文章。关于II期和III期临床试验的文章很少。本综述纳入了83篇文章。除了感染源控制方面的问题外,宿主对感染的免疫反应被列为败血症的主要潜在病理生理失调,并使治疗复杂化。间充质干细胞(MSCs)治疗为脓毒症提供了一个有希望的治疗选择。事实上,免疫调节特性、抗菌活性、对器官衰竭的保护能力、增强败血症后组织损伤的解决、组织修复和恢复,使MSCs在治疗与严重败血症和感染性休克相关的免疫和炎症功能障碍方面具有显著的优势。结论:MSCs治疗似乎具有合适的安全指标。未来的试验应注重提高研究质量,报道MSCs的治疗效果和不良事件。虽然早期的临床试验看起来很有希望并且有有益的效果,但我们需要更多的对照临床研究,特别是在II期和III期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sepsis and Septic Shock; Current Treatment Dilemma and Role of Stem Cell Therapy in Pediatrics
Context: Sepsis’s primary therapy consists of antibiotics therapy, supportive therapies, and source control of infection. The failure rate of this approach is about 20 - 40%. The widespread use of antibiotics has caused multiple drug resistance in primary etiological agents of sepsis in community-acquired and healthcare-associated infections. In the absence of new antibiotic options, alternative treatment modalities seem necessary. Evidence Acquisition: Herein, we have reviewed and discussed current problems with sepsis management and stem cell therapy in sepsis, preclinical, experimental studies, and early-phase clinical trials using stem cells to treat sepsis. In the preparation of the paper, PubMed, Web of Science Core Collection (Clarivate), Scopus, and the web address (www.clinicaltrials.gov) were searched by the keywords (sepsis and cell therapy, septic shock, and cell therapy). Results: After the inclusion of criteria, we reviewed 301 original articles. Few articles were found for phase II and phase III clinical trials. Eighty-three articles were included in the current review article. Besides problems with infection source control, the host immune response to the infection enumerated for primary underlying pathophysiologic dysregulation of sepsis and complicated the treatment. Mesenchymal stem cells (MSCs) therapy offers a promising treatment option for sepsis. Indeed, immunomodulatory properties, antimicrobial activity, the capacity of protection against organ failure, enhance the resolution of tissue injury, tissue repair, and restoration after sepsis confer MSCs with a significant advantage to treat the immune and inflammatory dysfunctions associated with severe sepsis and septic shock. Conclusions: It seems that MSCs therapy exhibits an appropriate safety index. Future trials should focus on strengthening study quality, reporting MSCs’ therapeutic effects and adverse events. Although early clinical trials seem promising and have beneficial effects, we need more controlled clinical studies, especially in phases II and III.
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来源期刊
CiteScore
1.80
自引率
14.30%
发文量
22
期刊介绍: Archives Of Pediatric Infectious Disease is a clinical journal which is informative to all practitioners like pediatric infectious disease specialists and internists. This authoritative clinical journal was founded by Professor Abdollah Karimi in 2012. The Journal context is devoted to the particular compilation of the latest worldwide and interdisciplinary approach and findings including original manuscripts, meta-analyses and reviews, health economic papers, debates and consensus statements of clinical relevance to pediatric disease field, especially infectious diseases. In addition, consensus evidential reports not only highlight the new observations, original research and results accompanied by innovative treatments and all the other relevant topics but also include highlighting disease mechanisms or important clinical observations and letters on articles published in the journal.
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